When pressure builds in radiology: a clinician’s perspective on backlogs, risk and responsibility
By Annabel Bentley MBBS FRCS, Group Chief Medical Officer, Medica Group
If you’re working in NHS radiology right now, you don’t need anyone to tell you that the pressure is real.
Across the country, reporting backlogs have become a persistent feature of day-to-day practice rather than a short-term blip. Many of us are concerned about aged examinations, scans we know matter to patients, but reporters simply don’t have the hours in the day to report as quickly as we would want.
Recent analysis from the Royal College of Radiologists shows that delays in reporting have reached their worst level on record, with close to a million patients waiting more than four weeks for scan results in a single year. That isn’t a statistic any of us are comfortable with, particularly when we consider the clinical risk and impact of delayed diagnosis on patients.
I’m writing this not as a spokesperson, but as a clinician who recognises these pressures because when I speak to radiologists, backlogs are one of the biggest concerns they bring to my attention.
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Reporting backlogs aren’t just an operational issue – they’re a professional one
When reporting backlogs build, the impact isn’t confined to dashboards or performance metrics.
They affect:
- Clinical confidence in decision making
- Cognitive load and fatigue across teams
- The professional anxiety that comes with knowing patients are waiting
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Many radiologists I speak to worry less about volume itself and more about clinical risk:
- Are older examinations being prioritised safely?
- Is quality being protected when pressure increases?
- Who is accountable when work is done outside the department?
These are legitimate professional concerns. They are also often what makes colleagues understandably cautious about outsourcing or external support.
There are concerns about “faceless teleradiology”: anonymous reporting, unclear governance, and loss of professional oversight. Why some reporting backlog solutions create more problems than they solve.
Nationally, outsourcing has become almost universal as departments try to stay afloat. But the way support is implemented matters enormously.
The Royal College of Radiologists has been clear that short-term fixes alone will not resolve the workforce crisis, and that poorly governed approaches can increase cost, risk, and pressure rather than relieve it.
From a clinical perspective, the pitfalls are familiar:
- Unclear scope or poorly defined cohorts
- Limited visibility of who is reporting what
- Fragmented communication back into referring clinicians
- Additional review burden landing back on local consultants
When that happens, support stops feeling like support.
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What “good” backlog support actually looks like
Over the past few years, I’ve seen that backlog support can work, but only when it’s designed with the same care and governance that is expected in-house.
In practice, that means:
- Backlog pathways that are clearly ring-fenced from BAU work
- Named, accountable radiologists delivering the reporting
- Transparent governance and quality assurance throughout
- Close alignment with Trust priorities and clinical risk thresholds
- Support that steps in at the point of pressure, and steps back when stability returns
In other words: visible clinicians, visible accountability, and visible results.
That is the standard we should expect.
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Why I work at Medica
I’m open about the fact that I work with Medica. What matters to me, as Group Chief Medical Officer, is that the way support is provided aligns with the professional standards and governance we expect within NHS services.
That means:
- Backlog support is designed and governed by NHS-experienced radiologists
- Reporting is never anonymous; named clinicians remain accountable throughout
- Clinical ownership, quality, and governance are explicit and visible
- Support is focused on stabilising services and protecting BAU work, working alongside local teams
We work in partnership with Trusts, listening, sharing what has worked elsewhere, and supporting colleagues to make informed, clinically safe decisions when pressure builds.
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An open invitation, not a sales pitch
If your department is currently carrying backlog pressure, or if you’re being asked to sign off on decisions that don’t feel entirely clear or defensible from a clinical perspective, you’re not alone; many colleagues are facing similar pressures.
Sometimes the most valuable first step isn’t a solution, but a conversation:
- to sense check your current approach from a clinical and governance perspective
- to compare it with models that have worked safely in other Trusts
- to understand which safeguards are worth insisting on
Those conversations don’t have to lead anywhere. But if sharing experience or exploring options helps protect your service, your colleagues, and your patients, we would welcome the chance to talk.
Radiology has never been faceless, and the support we use shouldn’t be either.
Get in touch today if we can provide backlog support for your Trust.
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About the author:
Annabel Bentley MBBS FRCS is Group Chief Medical Officer at Medica Group. She is an NHS trained surgeon and has held senior clinical leadership roles across independent healthcare organisations serving millions of NHS patients and other healthcare organisations, with board level responsibility for clinical governance, patient safety, and risk.
Annabel has established and chaired clinical risk committees, led culture change programmes, and led service responses to periods of sustained operational pressure such as the pandemic. She has previously served as Chief Medical Officer at AXA Health, Executive Medical Director at InHealth, and Medical Director at Bupa, and has been a Responsible Officer.
She provided expert evidence to the Paterson Inquiry (2020) and was a member of the Department of Health Expert Working Group for the first Information Standard. Annabel is passionate about protecting professional standards and ensuring diagnostic services remain safe, governed, and clinically accountable.